Inspection summaries and ratings from previous provider

Overall summary & rating

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Creech Medical Centre on 24 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

Risks to patients were assessed and well managed.

Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

Information about services and how to complain was available and easy to understand.

Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

The practice had good facilities and was well equipped to treat patients and meet their needs.

There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The provider was aware of and complied with the requirements of the Duty of Candour.

We saw two areas of outstanding practice:

The patient participation group (PPG) was prominently active within the practice and was involved in staff recruitment. They sat on the interview panel during recent interviews for a new practice manager; had arranged patient educational events; and as a result of their patient survey feedback, the appointment system had been revised and improved.

The practice worked with local ‘Village Agents’ to help provide support to isolated patients on their lists by providing information to patients who might benefit from extra support or contact.

The areas where the provider should make improvement are:

Review systems for recording alerts on the patient record system to ensure GPs, particularly locum GPs, are made aware of any concerns about patients.

Review the programme of audits to ensure practice performance can be measured effectively in the absence of the Quality and Outcomes Framework measures.

Review care plans to ensure they are routinely updated as well as following changes to patients’ needs or diagnosis.

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Inspection areas

Safe

There was an effective system in place for reporting and recording significant events

Lessons were shared to make sure action was taken to improve safety in the practice.

When there were unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes to prevent the same thing happening again.

The practice had clearly defined systems, processes and practices in place to keep people safe and safeguarded from abuse. However, information alerts would benefit from a review to ensure all vulnerable patients had an up to date alert in place.

Inspection report

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Responsive

Good

Updated 24 December 2015

The practice is rated as good for providing responsive services.

The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, participation in the Symphony project which provided new integrated care models for patients with long term conditions to ensure their wellbeing.

The practice was part of the Taunton Deane Federation of 14 GP practices which provided patients with wider access to locally based services rather than having to attend hospital.

Patients we spoke with during our inspection said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.

The practice had good facilities and was well equipped to treat patients and meet their needs.

Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Inspection report

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Well-led

It had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents

The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

There was a strong focus on continuous learning and improvement at all levels.

Inspection report

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Checks on specific services

People with long term conditions

The practice is rated as good for the care of people with long-term conditions.

Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

Longer appointments and home visits were available when needed.

All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The nursing team were experienced and qualified in all chronic disease management and provided regular nurse led patient reviews for patients with long term conditions. Longer appointments were provided, usually 30 minutes, for these patients. Patients were reminded of their appointment and had their regular investigations in advance of their appointment.

The practice had recently started working with a ‘Well-being Advisor’ via a local Symphony project (A project to support patients with three or more illnesses to be maintained in the community rather than in hospital). This advisor was the point of contact for patients with long term illnesses in order to stream line patient care.

Inspection report

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Families, children and young people

Good

Updated 24 December 2015

The practice is rated as good for the care of families, children and young people.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.

Patients told us children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

The practice’s uptake for the cervical screening programme was 78.98%, which was comparable to the national average of 81.88% and in line with other Taunton and Dean practices.

Appointments were available outside of school hours and the premises were suitable for children and babies.

We saw good examples of joint working with midwives, health visitors and school nurses.

GP’s carried out paediatric phlebotomy to help reduce the need to send patients to hospital based paediatric phlebotomy services, and provide the service in a familiar less stressful environment.

One of the GPs provided sex education talks to nine and ten year olds at the adjacent primary school as part of their education programme.

Inspection report

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Older people

Good

Updated 24 December 2015

The practice is rated as good for the care of older people.

The practice offered personalised care to meet the needs of the older people in its population. However, care plans were not always reviewed unless a change in the patient’s diagnosis prompted an update.

It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

The practice kept a list of patients from whom they would accept telephone prescription requests. The attached pharmacy, in conjunction with the practice, arranged home delivery of medicines to the patients as well as organising dossett boxes and trays to minimise any errors of taking medicines.

The practice worked with local ‘Village Agents’ (a Somerset community project) to help provide support to isolated patients on their list by providing information to patients who might benefit from extra support or contact.

Inspection report

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Working age people (including those recently retired and students)

Good

Updated 24 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Extended hours were offered on Monday, Wednesday and Thursday evenings between 6:30pm and 7pm and on Thursday mornings from 7am until 8am for pre-booked appointments for those patients who could not visit the practice during normal hours.

Inspection report

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People whose circumstances may make them vulnerable

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

The practice offered longer appointments for people with a learning disability if required and provided the appointments at times which suited the patient.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

They told vulnerable patients and their carers about how to access various support groups and voluntary organisations.

Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

Patients diagnosed with learning difficulties received an in-depth medical examination annually. During this examination, the problems of their disability were investigated, as well as considering general health promotion, for example, smoking cessation, alcohol use status and cardiovascular risk stratification.

Meetings were held every four weeks with the palliative care team to discuss any needs in the care of terminally ill patients.

Patients requesting an appointment for emotional or mental health concerns were given a double appointment.

Inspection ratings

We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels:

Outstanding – the service is performing exceptionally well.

Good – the service is performing well and meeting our expectations.

Requires improvement – the service isn't performing as well as it should and we have told the service how it must improve.

Inadequate – the service is performing badly and we've taken enforcement action against the provider of the service.

No rating/under appeal/rating suspended – there are some services which we can’t rate, while some might be under appeal from the provider. Suspended ratings are being reviewed by us and will be published soon.

Ticks and crosses

We don't rate every type of service. For services we haven't rated we use ticks and crosses to show whether we've asked them to take further action or taken enforcement action against them.

There's no need for the service to take further action. If this service has not had a CQC inspection since it registered with us, our judgement may be based on our assessment of declarations and evidence supplied by the service.

The service must make improvements.

At least one standard in this area was not being met when we inspected the service and we have taken enforcement action.